Document Type

Master's Culminating Experience

Publication Date



Objective: To compare how health departments in the southwest district of Ohio manage prenatal care, defined as preventative care provided immediately preceding, during, and following pregnancy, to determine if there is a better management technique based on cost and/or characteristics of jurisdictions.

Design: Qualitative descriptive analysis of prenatal services at local health departments in the southwest district of Ohio for 2004.

Setting and Participants: Health Departments in the southwest district of Ohio.

Main Outcome Measures: Comparison of the types of services currently being used to provide prenatal care services (i.e., direct, contracted, combination, or no service) including budgeting and cost comparisons between services and per client as well as population comparisons.

Results: Four departments provide full service clinics, two departments do a combination of contracting and direct service, one department contracts out all prenatal services and 22 departments provide no prenatal services. The percentage of the total budget that prenatal services comprise for those departments providing service is 1.7%, 3.3%, 8.9%, 6.8%, 3.3%, and 15.8%. Departments fund prenatal services in large part through grants and general revenue. Prenatal budgets for those providing full services were $537,000, $200,000, and $90,000. Prenatal budgets for those providing a combination of services and contracting were $271,003 and $92,048. The prenatal budget for the department that contracts services was $237,820. Cost per client for full service clinics was $1037, $1923, and $909. Cost per client for combination services was $1,613 and $268 and the cost per client for contract services was $259. Five departments that provide services do so because of lack of availability of services for the uninsured and the underinsured and the 6th department does it because services are not available at all. Of the 22 departments not providing services their reasons were; lack of funding (8 departments), lack of staff (2), lack of public demand (1), lack of public need (8), and other (3). All departments that provide prenatal services conducted needs assessments. Ten of the 22 departments not providing services conducted a needs assessment. The proportion of the departments conducting needs assessments for those providing services compared to those that do not provide services was significant (p =

Conclusions: The results do not indicate a better way to manage prenatal care in the southwest district of Ohio. It depends on the political climate, the availability of providers, and the financial ability of each department. Differences among health department services and cost comparisons at local health departments were unexplainable, but may be attributed to small regional variation in healthcare that has been documented in private medical care. More health departments should be conducting needs assessments as a tool for the decision making process.